GME Ombudsman Form

The Ombudsman is here to assist you with any complaints, concerns or problems you may encounter as a resident/fellow. To talk with an ombudsman, please complete this form. We are committed to providing you with assistance with the goal of helping you resolve any issues.

Please tell us what happened, when it occurred, and who was involved * What other steps have you already taken to notify someone about the incident?

Do you want us to investigate this incident or do you just want us to be aware of the incident? *

Please be aware Please investigate

Would you like this incident to remain confidential? *

Yes No

Would you like to be anonymous in reporting this incident? *

Yes No

Your name (optional) Your email address (optional)

Authentication *